The Health System of Taiwan: HCT Healthcare of Many Nations

The Health System of Taiwan: HCT Healthcare of Many Nations

it's been a while since we've added an episode to our playlist of international healthcare systems let's do another Taiwan is proof that a country can make a swift and huge changed its healthcare system even in the modern day it's also the topic of this week's healthcare triage the united states in part because of political stalemate part because it's been hemmed in by history has been unable to make bold changes to its health care system singapore which we talked about years ago tinkers with its health care system all the time taiwan in contrast revamped its system top-to-bottom in one fell swoop less than 25 years ago taiwan had a patchwork system that included insurance provided for those who work privately or for the government or for trade associations involving farmers and fishermen out-of-pocket payments were high physicians practiced independently and in March of 1995 all of that changed after talking to experts from all over the world Taiwan chose William Chou a professor of economics at the Harvard th Chan School of Public Health to lead a task force to design a new system of a Reinhardt a long time Princeton professor also contributed significantly to the effort dr. Reinhardt who died last month was a panelist on an upshot article that we did comparing international healthcare systems in a tournament format a couple months ago the taskforce studied countries like the United States Britain France Canada Germany and Japan much like healthcare triage in the end Taiwan chose to adopt a single-payer system like that found in Medicare where in Canada not a government-run and implemented system like in Britain at first things did not go as well as hoped although the country had been planning the change for years it occurred quite quickly after democracy was established in the early 1990s the system including providers and hospitals was caught somewhat off-guard and many felt that they'd not been adequately prepared the public however was much happier about the change today most hospitals in Taiwan remained privately-owned mostly non profit most physicians are still either salaried or self-employed in practices the Health Insurance Taiwan provides is comprehensive both inpatient and outpatient care covered as well as dental care over-the-counter drugs and traditional Chinese medicine it's much more thorough than Medicare as in the United States access is also quite impressive patients can choose from pretty much any provider or therapy wait times are reasonably short and patients can go straight to specialty care without a referral premiums are paid for by the government employers and employees the share paid by each depends on income with the poor paying a much smaller percentage than the wealthy taiwan's cost of health care rose faster than inflation as it has in many other countries in 2001 co-payments for care were increased and in 2002 they went up again along with premiums in those years the government also began to reduce reimbursement to providers after a reasonable number of patients was seen it also began to pay less for drugs finally it began to institute global budgets caps and the total amount paid for all care in the hope of squeezing providers into becoming more efficient relative to the United States and some other countries Taiwan devotes less of its economy to health care in the early 2000s it was spending 5.4 percent of GDP and by 2014 that number had risen to 6.2 percent by comparison countries in the OECD spend on average more than 9% of GDP on health care and the United States spends about twice that after the most recent premium increase in 2010 which by the way was only the second in their history the system began to run surpluses this is not to say that the system is perfect Taiwan is a growing physician shortage and physicians complain about being paid too little to work too hard although doctors and nearly every system complain about that Taiwan is an aging population and a low birth rate which will push the total cost of care upward with a smaller base from which to collect tax revenue Taiwan's done a pretty good job of treating many communicable diseases but more chronic conditions are on the rise these include cancer and cardiovascular and cerebrovascular disease all of which are expensive to treat the health systems quality could also be better although oacd data aren't available for the usual comparisons Taiwan's internal data show that it is a lot of room for improvement especially relating to cancer in many aspects of primary care taiwan could perhaps fix some of this by spending more as we've showed in our many episodes on international healthcare systems though complaints can be made about every system and the one the united states is certainly no exception for a country that spends relatively little on health care taiwan's accomplishing quite a bit preparing taiwan in the united states may appear to be like comparing apples in aardvarks one is geographically small with only 23 million citizens while the other is bad than home to well over 300 million but Taiwan is larger than most states and a number of states including Vermont Colorado and California have made pushes for single-payer systems in the last few years these have not succeeded however perhaps because there's less tolerance for disruption in the US than the Taiwanese were willing to accept regardless of which healthcare system you might prefer Taiwan's ambition shows what's possible it took five years of planning and two years of legislative efforts to accomplish its transformation that's less time than the United States has spent fighting over the Affordable Care Act with much less to show for it we love to make videos about things that sometimes YouTube doesn't like to sell to advertisers and we're fine with that because what we do is more important than the money we might make that said any sport you can give us to help keep the show going helps to make it bigger and better I'm one good way to do that is through a subscription service called patreon com you can go to care triage give as little as one dollar a month to help the show keep going if you don't that's fine we're gonna keep on making it anyway we'd also appreciate if you subscribe to the show maybe like the video if you liked it that'd be great too we'd especially like to thank our surgeon Admiral Sam and our Research Associates Joe sevenths and Karla's here we also have some great merchants like we have mugs and posters and lunch boxes and other stuff and you can check it all out at HC team merch com I also have my book still available anywhere books are sold the bed through Bible and really appreciate if you pick up a copy you


  1. In the US when you have a fever and you call your doctor, you will have an appointment in 2 weeks. In the US when you're feeling sick, you go to the pharmacy. In the US, WITH health insurance, I paid $500 for an MRI, that's right with insurance it cost 500. In Taiwan, without ANY healthcare or insurance, it'll cost you $200 for an MRI, with healthcare, it cost me $8. In Taiwan, people pay around $5 each visit to a clinic (including meds), and they pay $12 to go to a big hospital doctor. Don't get me wrong there are bad things about the TW hospitals, sometimes popular doc/hospital gets crowed and need to wait for beds to open up. But TW healthcare will cost you $200 a YEAR, I'm paying $300 a MONTH in the US, and the last doc appointment cost me $100 for an x ray. In TW you'd easily be able to get a doctor check you out immediately if you're feeling unwell, and only pay $5 out of your pocket. TW healthcare is "losing money" though, but that's the beauty: patients shouldn't have to suffer for your profitability. This is health we are talking about. Now people in the US, imagine paying $200 a year for healthcare and pay almost nothing for whole year worth of checkups and visit.

  2. Can you do one for Brazil's SUS? Its really a great free healthcare system (maybe one of the top ones relating to coverage). Though its soo beautifull in the law, in reality it's application is rather flaw. Underfunding by the government, too much lobby by the private sector and many issues with the local management by counties and states. Some 75% os Brazilians depends on SUS, usualy the poorest 75% of the people. Paradoxaly private companies originates more than half of total healthcare spending.

  3. Would enjoy an episode on mainland China's system, it's a major nation and it would be interesting to know how you provide health care for over a billion people. A future episode on Japan would be nice. Plus maybe a historical episode on what the Soviet union's healthcare system was like, I'm just curious to know what a socialized system of medicine in a truly communist nation looks like. Thanks great series.

  4. First of all,thanks for the overview of health system around the world.My country spends just around 1.3% of GDP on Healthcare even though it's poverty contribution is around 16% overall. However, the revamped proposed Healthcare -Ayushman Bharat sounds quiet grand.If possible ,please consider doing a take on Indian healthcare system.It would definitely help many to look at comparison and catalyse the debate within India

  5. This channel's playlist named "International Health Care Systems" appears to be in backward release order until you reach this video. If you watch the playlist with its current ordering, many videos reference information covered in videos that come along afterward in the (current) viewing order. Unfortunately, the information is still presented as though you've already watched the previous videos in the correct order…

  6. Despite what leftists tell you, the united states is not unique in the lack of universal healthcare. Turkey doesn't have universal healthcare either.

  7. Could you do Israel next? It's an interesting mix of public private with hospitals being public and daily care being semi private.

  8. Oh yeah, Taxes are lower, Infrastructure is not crumbling, and we have a military strong enough to deter a chinese invasion.

  9. You should do a video on New Zealand's healthcare system. It's unusual as it has a socialised public element, a private insurance element, and a government monopoly for-profit insurance scheme which covers healthcare needs from accidents (called ACC). The latter system is no-fault and means that protect individuals from civil liability in for accidental injury. In short, if I crash my car into yours, you can sue me for the damage to your car, but ACC will cover your healtcare, rehabilitation, and loss of income costs.

  10. I'm about to make a Video about Health Care service and finance. I think the best model for a Health care system would be one modeled after that of ancient China, where instead of Paying your Doctor when you're sick, you pay them or the Organization they work for, a retainer to keep you healthy.
    -Your Insurance provider and Health care provider would one and the same.
    -Health care providers have huge advantage over Patients, in that they actually do have the resources and Know-how to go up against Drug companies. So having the health care provider also bare the cost of treatment and medicine, will have them seek the most cost-effective method to get you healthy as soon as possible and keep you that way for as long as possible. This would drive up the quality of care, while also driving down the costs of care, as promised by Free Market Health care theory.
    -To have Universal access, Public money that would have gone towards a Public Health care system, can instead be used to pay for such Retainers with reimbursable Vouchers. If a Patient finds and picks a service that is cheaper than the Voucher's limit, they can keep the change. If it Exceeds the Voucher's limit, they would only pay the difference out of their pocket.
    – There would be a separate scheme for Emergency care.

  11. do you have a video that talks about ways to expand the medical supply of care such as retail clinics and expanding duties of care to NP (nurse practitioners with more training), pharmacists and PA?

  12. From what I've learned, a lot of drugs are quitting from Taiwan and probably never coming back, because drugs' prices are highly regulated and keep being cut or bring down by the Bureau Of National Health Insurance(it's only a sum to be granted every year so they want drugs as cheap as possible). That and exploiting doctors by not include them in the labor law are the reasons why the health system in Taiwan appears to be better than other countries: forced cheap labors and keep down the prices of drugs. The results are patients no longer have their best drugs to use, and doctors running away from major practices like surgery, gynecology, pediatrics and emergency department. Instead they are going to plastic surgery industry, not just because the profits are higher, but they are less likely to overwork and die in early age there.
    The two problems are just the tip of the iceberg. It's a sinking ship and I hope people know the facts before praising it.

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